Community Mobilization to Improve the HIV/AIDS Continuum of Care Among Black Men

描述(由申请人提供)：青年黑人男男性行为者(YBMSM)的艾滋病毒感染率处于灾难性的水平。美国21个城市的一项研究发现，18-29岁的YBMSM中有21%的人是HIV+，而拉丁裔和白人年轻MSM(YMSM)的这一比例分别为9%和7%，而且这些差距正在恶化。与其他族裔/种族的男性相比，YBMSM更有可能感染艾滋病毒，不太可能意识到自己感染了艾滋病毒，也不太可能透露自己感染了艾滋病毒。与白人MSM相比，HIV+YBMSM接受艾滋病毒治疗和病毒载量(VLS)检测的可能性也较小。当艾滋病毒携带者达到无法检测到的VL时，他们自己的健康状况会得到改善，他们对其他人的传染性也会降低。然而，要达到这一点，需要艾滋病毒携带者：(1)了解他们的艾滋病毒状况；(2)与艾滋病毒护理有关；(3)长期接受护理；(4)开始适当的治疗；以及(5)坚持抗逆转录病毒治疗。 治疗(ART)。我们将这些步骤称为参与艾滋病毒护理连续体(CC)。虽然这些方法具有降低艾滋病毒发病率的巨大潜力，但据估计，在美国只有25%的HIV+患者参与了CC，以至于无法检测到VLS。研究表明，HIV+YBMSM比其他人参与CC的次数要少得多。社区一级的干预(CLI)旨在建立和动员基督教青年会社区，以支持艾滋病毒+男性参与社区合作，减少心理社会障碍，并增加心理社会促进者，在这些社区内参与社区合作，这可能是预防艾滋病毒传播和改善青壮年男性健康状况的有效方法。这项提议将测试这种名为联合黑色元素+(UBE+)的CLI模型的有效性。UBE+将是当前CLI的改编，称为UBE。UBE已经在德克萨斯州达拉斯招募了数百名YBMSM，它通过建立一个授权的、动员起来的YBMSM社区，传播对艾滋病毒预防的支持，并围绕降低无保护性行为的比率和增加定期艾滋病毒检测创造积极的社会规范。UBE+将是UBE的改编和延伸，旨在增加YBMSM在CC中的参与度。该项目的目标是：(1)将UBE调整和扩展为UBE+，这是一种多层次的干预措施，包括一个新的重点，即增加HIV+YBMSM在CC中的参与度，包括针对心理社会障碍和在该社区有经验的参与CC的促进者(例如，HIV耻辱和社会支持)；(2)与目前实施UBE的当地艾滋病服务组织、达拉斯县卫生局和德克萨斯州卫生服务部(TDSHS)HIV-STD计划合作，在达拉斯实施UBE+为期3年；以及(3)使用两种独立的方法评估UBE+在增加达拉斯社区保健参与度方面的效果(以休斯敦为对照社区)：(A)由艾滋病毒+YBMSM组成的纵向队列，提供参与护理的数据、心理社会和后勤障碍以及参与护理的促进者的经验；以及(B)TDS HS独立收集关于HIV+YBMSM参与CC的公共卫生数据。

DESCRIPTION (provided by applicant): HIV rates are at catastrophic levels among young black men who have sex with men (YBMSM). A study in 21 US cities found that 21% of YBMSM aged 18-29 were HIV+, compared to 9% of Latino and 7% of white young MSM (YMSM), and these disparities are worsening. YBMSM are more likely to be HIV-infected, less likely to be aware of their HIV-infection, and less likely to disclose that they are HIV-infected, relative to men of other ethnic/racial groups. HIV+ YBMSM are also less likely than white MSM to be in treatment for HIV and to have undetectable viral loads (VLs). When HIV+ individuals achieve an undetectable VL, their own health improves, and they are also less infectious to others. Getting to that point, however, requires that HIV+ individuals: (1) know their HIV status; (2) link to HIV care; (3) stay in care over time; (4) begin appropriate treatment; and (5) adhere to antiretroviral therapy (ART). We refer to these steps as engagement in the HIV Care Continuum (CC). While these approaches have great potential to reduce HIV incidence, it is estimated that only 25% of HIV+ people in the US have engaged in the CC to the point of having undetectable VLs. Research suggests that HIV+ YBMSM engage in the CC far less than others. A community-level intervention (CLI) to build and mobilize communities of YBMSM to support HIV+ men to engage in the CC, decrease psychosocial barriers and increase psychosocial facilitators to engage in the CC within those communities may be an efficacious approach to prevent HIV transmission and improve health outcomes for YBMSM. This proposal will test the efficacy of such a CLI model, called United Black Element+ (UBE+). UBE+ will be an adaptation of a current CLI, called UBE. UBE has already engaged hundreds of YBMSM in Dallas TX, and it diffuses support for HIV prevention and creates positive social norms around reducing rates of unprotected sex and increasing regular HIV testing by building an empowered, mobilized YBMSM community. UBE+ will be an adaptation and extension of UBE designed to increase YBMSM's engagement in the CC. The aims of this project are: (1) To adapt and expand UBE into UBE+, a multilevel intervention that includes a new focus on increasing engagement in the CC among HIV+YBMSM, including targeting psychosocial barriers and facilitators to engaging in the CC that are experienced in this community (e.g., HIV stigma and social support); (2) To implement UBE+ in Dallas for 3 years in collaboration with a local AIDS Service Organization currently implementing UBE, the Dallas County Health Department, and the Texas Department of State Health Services' (TDSHS) HIV-STD Program; and (3) To evaluate the efficacy of UBE+ in increasing engagement in the CC in Dallas (utilizing Houston as a control community) using 2 independent methods: (a) a longitudinal cohort of HIV+ YBMSM providing data on engagement in care, and experiences of psychosocial and logistic barriers and facilitators to engagement in care; and (b) public health data that the TDSHS independently collects on HIV+ YBMSM's engagement in the CC.